The causal effect of education and cognitive performance on risk for suicide attempt: A combined instrumental variable and co-relative approach in a Swedish national cohort

Lannoy, Séverine; Kendler, Kenneth S.; Sundquist, Jan; Sundquist, Kristina; Edwards, Alexis C.

doi:10.1016/j.jad.2022.03.004

Cited by 6 publications

(4 citation statements)

References 40 publications

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“…Concerning proximal environmental factors, our study reinforced the role of financial stressors [ 17 ], by specifically showing that being unemployed, receiving social welfare and having a low education the year before SUD registration were associated with the first suicide attempt among individuals with SUD. These variables are indicators of the economic situation, whereas low education might also be related to cognitive performance and personality traits [ 40 ]. Low education was significant in all models, with an effect size comparable to parental death.…”

Section: Discussionmentioning

confidence: 99%

Risk of non‐fatal suicide attempt in individuals with substance use disorder: the roles of aggregate genetic liability and environmental exposures in a Swedish population‐based cohort

et al. 2022

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Background and Aims: Substance use disorder (SUD) is related to widespread adverse consequences, including higher suicidality. Shared genetic liability has been demonstrated between SUD and suicidality. Here, we measured the factors that contribute to increased risk of non-fatal suicide attempt among individuals with SUD by focusing upon aggregate genetic risks and both childhood and past-year environmental factors.Design: Longitudinal study. Family genetic risk scores and environmental factors (childhood, aged from 0 to 15 years, and the year preceding SUD registration) were used to predict the relative risk of non-fatal suicide attempt using Cox proportional hazards models. Additional analyses employed a co-relative design, accounting for genetic factors and shared familial environment, to test for potential causality.Setting and participants: Based on longitudinal Swedish registry data, 228 617 individuals with SUD registrations from 1991 to 2015 were included.Measurements: SUD and suicide attempts were identified using medical records (International Classification of Diseases codes). SUD was also identified using pharmacy and criminal registries.Findings: In multivariable analyses that jointly accounted for all the selected potential predictors, individuals with SUD were at higher risk for non-fatal suicide attempt if they had experienced a parental death [hazard ratio (HR) = 1.58; 95% confidence interval (

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Section: Discussionmentioning

confidence: 99%

Risk of non‐fatal suicide attempt in individuals with substance use disorder: the roles of aggregate genetic liability and environmental exposures in a Swedish population‐based cohort

et al. 2022

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“…Higher per capita GDP also enables higher health expenditures, and this may reduce suicide deaths through greater access of the population to mental healthcare and other suicide‐preventive programs. Moreover, typically, a higher per capita GDP is associated with higher levels of educational attainment in populations, and higher educational attainment, other things equal, appears to be negatively related to suicides (Lorant et al., 2005; Phillips & Hempstead, 2017; Rosoff et al., 2020; Lannoy et al., 2022). This can be taken to reflect that education often provides additional social contacts to an individual, as well as the opportunity to change his/her class position and become socially more significant over time, something that tends to decrease suicide risk.…”

Section: Model Specification and Empirical Resultsmentioning

confidence: 99%

Suicide mortality, long‐term unemployment, and labor‐market policies: Evidence from European countries

Goulas

Zervoyianni

2023

Bulletin of Econ Res

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Using data from 25 EU countries spanning the period 1999–2017, this paper examines the relationship between working‐age suicides and changes in long‐term unemployment and tests for mitigating effects through the implementation of labor‐market policies. The estimates suggest higher suicide risks following a rising rate of long‐term unemployment. Passive support policies have a suicide‐decreasing impact. Among active policies, a significant suicide‐decreasing effect is found for training and direct job creation. The results have important policy implications in that they suggest that strong commitment of governments to passive or to certain types of active labor‐market policies can, on average, contribute to social stability and the welfare of populations.

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“…However, a recent meta-analysis of studies conducted in general populations indicates that these associations were weak to modest [ 34 ]. Moreover, individuals with AUD and internalizing symptomatology are characterized by higher educational attainment, which is an important and potentially causal protective factor for suicidal behavior [ 35 , 36 ]. Individuals in this subgroup also have a later age of AUD onset, suggesting that AUD might be a consequence of internalizing disorders whereas, in other groups, AUD is hypothesized as a causal factor for suicidal behavior [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Risk of suicidal behavior as a function of alcohol use disorder typologies: A Swedish population‐based study

Lannoy,

Ohlsson,

Kendler

et al. 2023

Addiction

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Background and aimsAlcohol use disorder (AUD) is one of the strongest predictors of suicidal behavior. Here, we measured risk of suicide attempt and death as a function of AUD typologies.DesignWe used AUD typologies from previous latent class analysis: (i) externalizing subtype (characterized by externalizing symptomatology and early age of onset; individuals in this group have lower education and higher familial/social difficulties); (ii) subtype described by minimal psychopathology; and (iii) internalizing subtype (characterized by internalizing symptomatology and later age of onset; individuals in this group have higher education). We used class membership to predict distal outcomes (attempt and death) and performed regressions to evaluate whether differences in suicidal behavior were explained by the group characteristics (sex, age of onset, number and type of AUD registrations, familial/genetic risk for AUD, externalizing and internalizing behaviors, socio‐economic indicators, marital status and childhood family status). We also evaluated the effect of suicide attempt prior to AUD.Setting and participantsBased on longitudinal Swedish registry data, we included 217 074 individuals with AUD born 1950–80.MeasurementsSuicide attempts were identified using medical registers and deaths using the mortality register.FindingsIndividuals with the externalizing subtype had higher risks of suicidal behavior than other groups [attempt: externalizing versus minimal psychopathology: odds ratio (OR) = 1.35, 95% confidence interval (CI) = 1.35, 1.35; externalizing versus internalizing: OR = 1.47, 95% CI = 1.46, 1.48; death: externalizing versus minimal psychopathology: OR = 1.57, 95% CI = 1.57, 1.58; externalizing versus internalizing: OR = 1.99, 95% CI = 1.93, 2.06]. Individuals with minimal psychopathology had higher risks than those with internalizing symptomatology (attempt: OR = 1.09, 95% CI = 1.08, 1.10, death: OR = 1.26, 95% CI = 1.23, 1.30). These differences were explained by age at registration and were related to the number of registrations, sex, education, family disruption and suicide attempt prior to AUD.ConclusionsAmong people in Sweden, considering alcohol use disorder (AUD) heterogeneity appears to be a meaningful way to evaluate suicide risk. The highest risk of suicide attempt and death occurs in the externalizing subtype of AUD, followed by the minimal psychopathology subtype, and then the internalizing subtype.

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The causal effect of education and cognitive performance on risk for suicide attempt: A combined instrumental variable and co-relative approach in a Swedish national cohort

Cited by 6 publications

References 40 publications

Risk of non‐fatal suicide attempt in individuals with substance use disorder: the roles of aggregate genetic liability and environmental exposures in a Swedish population‐based cohort

Risk of non‐fatal suicide attempt in individuals with substance use disorder: the roles of aggregate genetic liability and environmental exposures in a Swedish population‐based cohort

Suicide mortality, long‐term unemployment, and labor‐market policies: Evidence from European countries

Risk of suicidal behavior as a function of alcohol use disorder typologies: A Swedish population‐based study

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